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Leading representatives from the alcohol harm reduction, children's, homelessness and religious sectors have today called for action on the harm done by cheap alcohol.
43 organisations and experts have written to the Chancellor calling on him to implement targeted measures such as a minimum unit price for alcohol and increased taxes on high strength white cider, to lower the burden of cheap alcohol on our most vulnerable groups, our NHS and public services, and the economy.
Their call comes in response to a report released today by Public Health England, which finds that raising the price of the cheapest alcohol products is the most powerful tool at the Government's disposal to tackle the harm done by the cheapest alcohol.
The report, published in the Lancet, explains that alcohol is the leading cause of ill health, early death and disability amongst 15-49 year olds in England, and results in 167,000 years of working life lost. The report estimates the annual cost of alcohol harm to the UK in 2016 to be between 1.3% and 2.7% of GDP, which equates to £27billion and £52billion.
In October 2016, a review of alcohol prices by the Alcohol Health Alliance UK found an abundance of cheap, high strength drinks across the UK. Researchers were able to find products like high strength white ciders, which are predominantly drunk by dependent and underage drinkers, available for as little as 16p per unit. This means that for the cost of a standard off-peak cinema ticket it is possible to buy almost seven and a half litres of high strength white cider, containing as much alcohol as 53 shots of vodka.
Last month, a study found that, in England alone, the introduction of a 50p minimum unit price could reduce alcohol deaths by around 7,200, and reduce healthcare costs by £1.2 billion over 20 years.
Responding to the Public Health England report, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:
"This report provides yet more evidence of the effectiveness of raising the price of the cheapest alcohol to tackle alcohol-related harm.
Increased duty on the cheapest drinks, alongside minimum unit pricing, would make a real difference to the lives of some of our most vulnerable groups and ease the burden on our health service. These measures would also lower the burden of premature mortality due to alcohol, thereby increasing economic output.
At the same time, ordinary drinkers will not be penalised. Minimum unit pricing will leave pub prices untouched, and tax on the cheapest, strongest drinks will be targeted at those drinks which are preferentially consumed by harmful and dependent drinkers".
For further information, please contact Matt Chorley, the AHA's Policy and Communications Officer, at email@example.com or on 0203 075 1726.
A new study of HBV patients shows that the protective effect against cirrhosis of being female is gradually lost with increasing age.
This multicentre study from China investigated the interaction of female gender and older age on the development of cirrhosis in patients recorded in the China Registry of HBV. A total of 17,809 chronic HBV patients were studied.
The prevalence of cirrhosis in the females increased faster than that in the males over 50 years old. Multivariate analysis showed that the increase of adjusted odds ratios for developing cirrhosis in females started to accelerate after 50 years of age: 11.19 in women versus 14.75 in men aged 50 to 59; 21.67 versus 24.4 at ages 60 to 69; and 18.78 versus 12.09 in those aged over 70.
The study authors suggest that disease progression should be monitored more closely in elderly women with chronic HBV.
Female gender lost protective effect against disease progression in elderly patients with chronic hepatitis B. You H, Kong Y, Hou J et al. Sci Rep. 2016 Nov 28;6: 37498
Two otherwise unrelated studies have testified to the efficacy and safety of the combination of simeprevir and sofosbuvir in patients with HCV.
In the US-based GALAXY study, the combination, with or without ribavirin, was efficacious and well tolerated in patients with recurrent HCV genotype 1 post-orthotopic liver transplant (1).
Thirty-three such patients without cirrhosis were randomised into three arms: Arm 1, received simeprevir+sofosbuvir+ribavirin for 12 weeks; Arm 2, received simeprevir+sofosbuvir for 12 weeks; Arm 3 received simeprevir+sofosbuvir for 24 weeks; 13 additional subjects (two with cirrhosis, 11 without cirrhosis) entered Arm 3.
Among the randomised subjects, SVR12 was achieved by 81.8% in Arm 1, 100% in Arm 2, and 93.9% in Arm 3; two subjects did not achieve SVR12: one viral relapse
(follow-up Week 4; Arm 1) and one missing follow-up Week 12 data. Five subjects had a serious adverse event, considered unrelated to treatment per investigator.
In Spain’s PLUTO study, the combination of simeprevir plus sofosbuvir for 12 weeks resulted in SVR12 rates of 100% in treatment-naïve and -experienced patients with HCV genotype 4 with or without compensated cirrhosis, and was well tolerated (2).
Forty patients received the combination for 12 weeks. Seven of the patients had compensated cirrhosis. All achieved SVR12. Adverse events, all Grade 1 or 2, were reported in 20 patients. No serious adverse events were reported and no patients discontinued study treatment. Grade 3 treatment-emergent laboratory abnormalities occurred in two patients.
Efficacy and safety of simeprevir and sofosbuvir with and without ribavirin in subjects with recurrent genotype 1 hepatitis C post-orthotopic liver transplant: the randomized GALAXY study. O'Leary JG, Fontana RJ, Brown K et al. Transpl Int. 2016 Nov 29 [Epub ahead of print]
Simeprevir in combination with sofosbuvir in treatment-naïve and -experienced patients with hepatitis C virus genotype 4 infection: a Phase III, open-label, single-arm study (PLUTO). Buti M, Calleja JL, Lens S et al. Aliment Pharmacol Ther. 2016 Nov 29 [Epub ahead of print]
The overall rate of increase in hepatocellular carcinoma (HCC) slowed between 2010 and 2012, found a nationwide US study. However, it did increase in some sub-groups such as men aged 55 to 64, and whites/Caucasians.
Researchers at Baylor College of Medicine in Texas analysed data from the US Cancer Statistics registry, which covers 97% of the population of all 50 states.
They found that the HCC incidence increased from 4.4/100,000 in 2000 to 6.7/100,000 in 2012, increasing by 4.5% annually between 2000 and 2009, but only by 0.7% annually between 2010 and 2012.
The average annual percentage change (AAPC) between 2000 and 2012 was higher in men (increase of 3.7%) than women (increase of 2.7%), and highest in 55 to 59-year-olds (AAPC 8.9%) and 60 to 64-year-olds (AAPC 6.4%).
By 2012, rates in Hispanics surpassed those in Asians, and rates in Texas surpassed those in Hawaii (9.71/100,000 vs 9.68/100,000). Geographic variation within individual race and ethnic groups was observed, but rates were highest in all major race and ethnic groups in Texas.
Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through
2012. White DL, Thrift AP, Kanwal F et al. Gastroenterology. 2016 Nov 23 [Epub ahead of print]
MPs have called for improved support for the hundreds of people living with illnesses derived from contaminated blood transfusions.
Voting in the House of Commons last week, MPs backed a call for funds to be used from the sale of Plasma Resources UK, a sum of £230 million.
The MPs also expressed concern at government plans to hand the management of the support scheme in England to the private sector.
In a vote backed by members of all parties, MPs stated that the "contaminated blood scandal was one of the biggest treatment disasters in the history of the NHS."
The government says it has already taken new steps to help those affected. There is to be a new payment of £3,500 a year for those newly diagnosed with stage 1 hepatitis C linked to contaminated blood.
But MPs voted that this was "not commensurate with the pain and suffering caused," calling for help for bereaved families. And they called for recipients to have the choice of taking lump sum compensation.
Introducing the debate, the Labour MP for Kingston upon Hull North, Diana Johnson, said: "Although we are all agreed on the need for a reformed scheme, I cannot agree with the Department of Health that its proposed settlement is sufficient."
Ms Johnson told MPs about Glen Wilkinson, diagnosed with hepatitis C after a dental procedure at the age of 19. She said: "He has had to live with the virus all his life and is still waiting for proper recognition of how it has affected him. I hope that the Minister and the Government will now work to ensure that Glen and others can live the rest of their lives in dignity."
Former Conservative health minister Alistair Burt raised the issue of people co-infected with HIV and hepatitis C. He said some 250 remain alive out of 1,200. Mr Burt said: "This is a collective shame, because Government after Government have not grasped that this just needs a final settlement. We can find the money for other things."
Health minister Nicola Blackwood rejected calls for a public inquiry, claiming it would not provide further information. She said: "I believe it is right that the Government’s focus is on considering how best to create and implement a system with the increased budget that is affordable, that redesigns the inconsistencies that we have heard about, and supports those most affected by these tragic events now and into the future."
A comparison of three different anti-HCV regimens concluded that all of them appeared highly effective in achieving sustained virologic response (SVR).
A study at the University of Southern California compared the SVR rates achieved 12 weeks post-treatment in 11,464 patients treated with three such agents by the Veterans Health Administration.
Without controlling for other risk factors, a SVR at least 12 weeks post treatment was achieved in 92% of ledipasvir/ sofosbuvir, 86% of ombitasvir/paritaprevir/ritonavir/dasabuvir, and 83% of simeprevir/sofosbuvir patients.
After adjusting for patient characteristics, simeprevir/sofosbuvir (93.3%) and ledipasvir/sofosbuvir (96.2%) patients were statistically more likely than ombitasvir/paritaprevir/ritonavir/dasabuvir (91.8%) patients to demonstrate a SVR.
HIV, HBV, diabetes, obesity, previous treatment history and augmentation therapy using ribavirin did not impact the SVR rates. Sustained SVR rates were lower for patients under age 65, with cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, indications of fibrosis or a non-genotype 1 infection. Women and Caucasian patients were more likely to achieve a SVR.
Comparative treatment effectiveness of direct acting antiviral regimens for hepatitis C: data from the Veterans Administration. Fox DS, McGinnis JJ, Tonnu-Mihara I et al. J Gastroenterol Hepatol. 2016 Nov 21 [Epub ahead of print]
A new study finds that people with viral hepatitis are at an increased risk of uveitis, particularly those with both HBV and HCV.
Researchers at China Medical University, Taichung, used data from the Taiwan National Health Insurance system to identify 17,389 patients newly diagnosed with viral hepatitis between 2000 and 2011 and matched these with 34,778 controls.
The risk of uveitis in the hepatitis cohort was 1.30-fold. Those with HBV and HCV coinfection had the highest risk (hazard ratio = 2.88), followed by HCV only infection (hazard ratio 1.75). Patients with cirrhosis had a higher risk in the multivariable model but did not attach statistic difference.
Relationship between uveitis, different types of viral hepatitis, and liver cirrhosis: a 12-year nationwide population-based cohort study. Tien PT, Lin CJ, Tsai YY et al. Retina. 2016 Dec;36(12):2391-2398
The use of statins by people with type 2 diabetes may help them avoid developing hepatocellular carcinoma (HCC), new evidence suggests.
Researchers at Yonsei University College of Medicine in Seoul, carried out a Korean nationwide population-based study involving 47,738 patients with type 2 diabetes.
After at least a five-year HCC-free period there were 229 incident HCC cases and 1,145 matched controls. Of these 229 incident HCC cases, 27 were statin users, whereas 378 were statin users among 1,145 controls.
Statin use was associated with a reduced risk of HCC development (adjusted odds ratio 0.36) after adjustment for chronic viral hepatitis, liver cirrhosis, alcoholic liver disease, previous cancer, aspirin use, insulin use, sulfonylurea use, metformin use, thiazolidinedione use, history of chronic obstructive pulmonary disease, Charlson comorbidity score, household income level, and residential area.
The risk reduction was accentuated with an increase of cumulative defined daily doses (cDDD) compared with non-users (adjusted odds ratios 0.53, 0.36, 0.32, and 0.26 in ≤60, 60-180, 181-365, and >365cDDD, respectively).
The risk reduction was apparent in the presence of liver disease (adjusted odds ratio 0.27), including heterogeneous groups of clinical diagnosis of liver disease, but not significant in the absence of liver disease (adjusted odds ratio 0.64).
Effect of statin on hepatocellular carcinoma in patients with type 2 diabetes: A
nationwide nested case-control study. Kim G, Jang SY, Han E et al. Int J Cancer. 2016 Nov 7 [Epub ahead of print]